Prehypertension is an increasingly common diagnosis in this country and is a predictor of a future hypertension diagnosis. Current guidelines recommend lifestyle modifications for prehypertension treatment. This study attempts to evaluate the provider, physician, and patient-related factors that affect whether physicians provide lifestyle counseling to patients with prehypertension. This study is a cross-sectional, retrospective cohort study using the 2007–2010 datasets from the National Ambulatory Medical Care Survey. The analysis sample included 2,804 patient visit records of prehypertensive patients. The outcome variable is whether any lifestyle counseling that included smoking cessation, dietary change, and/or weight loss was provided. A logistic regression model was constructed to assess the effects that patient, physician and provider characteristics had on the outcome variable. Out of the total analysis sample of 2,804, 30% of the patients received at least one form of lifestyle counseling. Patient factors that were statistically significant included: having diabetes (odds ratio (OR)=2.32, 95% confidence interval (CI), 1.70–3.17), being over-weight (OR=1.64, 95% CI: 1.25 – 2.15), being identified as smokers (OR=1.65, 95% CI: 1.19–2.29). Significant provider characteristics included solo practices (OR=0.67 95% CI: 0.50–0.90); having electronic health record system with a patient problem list feature (OR=1.46, 95% CI: 1.08–1.98), electronic reminders of clinical guidelines (OR=1.42, 95% CI: 1.03–1.96), and medical/surgical physician specialty (OR=0.67, 95% CI: 0.45–0.99). Among the financial factors, only the percent revenue from Medicaid was significant, with the 26–75% Medicaid revenue having an OR of 0.45 (95% CI: 0.29–0.71) compared with the 0–25% reference level.

Hepatitis B is a liver disease caused by the hepatitis B virus infection. The likelihood of acute hepatitis B to progress to chronic hepatitis B, which significantly increases the risk of developing cirrhosis and hepatocellular carcinoma, is inversely related to the age of infection. At least 50% of the estimated 250 million individuals with chronic hepatitis B worldwide were infected through mother-to-child transmission or during early childhood, especially in areas where hepatitis B is highly endemic. Increased risk of perinatal transmission is associated with high levels of viremia in pregnant women. Thus, the hepatitis B birth dose, administered to infants within 24 hours of birth, is the main modality in the prevention of perinatal transmission and can prevent around 90% of infants infected at birth from becoming chronic carriers. Although the hepatitis B vaccine has been commercially available for almost four decades, and has been proven to be effective and safe with correct storage and administration, hepatitis B remains a serious global health issue. Low and middle-income countries are disproportionately affected by hepatitis B with an estimated 45% of global population residing in an area of high hepatitis B prevalence where most infections are acquired perinatally. Furthermore, chronic hepatitis B infection accounts for around 45% of hepatocellular carcinoma cases, the sixth most common cancer worldwide and third most common cause of cancer-related death in Asia. The low hepatitis B immunization coverage is due to the multiple barriers to effective vaccination in low and middle- income countries. These barriers include the need for trained personnel to administer hypodermic injections, risk of sharps, vaccine refrigeration management, high cost of vaccine/vaccination, need for vaccine reconstitution, and vaccine wastage due to multi- dose vials. To address several vaccination barriers and increase vaccination coverage, transdermal immunization with microneedle patches has been proposed as an alternative to conventional liquid vaccine formulations injected intramuscularly with hypodermic needles. There have been several studies and clinical trials on the use of microneedle patches for influenza vaccination that showed promising results. However, there is currently very limited information regarding the use of microneedle patches specifically for hepatitis B vaccination. Thus, this paper aims to explore the potential use of microneedle patches for hepatitis B vaccination by analyzing the effectiveness, usability, and acceptability of the vaccine. Recent studies have shown that microneedle patches with hepatitis B vaccine not only produced similar immunogenicity to that of a single injected hepatitis B vaccine but was also able to maintain antibody titers for a longer duration. Microneedle patch-based hepatitis B vaccine is also significantly more thermostable than conventional liquid formulations, which could drastically reduce vaccine cost and wastage. Finally, health care workers and vaccine administrators overwhelmingly preferred microneedle patches over hypodermic needles for vaccination. These results support the outstanding potential of microneedle-patch based hepatitis B vaccines to address several challenges with existing vaccines and to increase vaccine coverage, especially in low and middle-income countries with high hepatitis B prevalence.

Maternal mortality has long been a gauge for the health of a nation. It represents not only the health of women in that country but the health of the nation as a whole. The world experienced a steep decline in maternal mortality ratio (MMR) in the early 20th century, but since the 1990s the United States (U.S.) has had a troubling upwards trend in maternal deaths. Given its status as the only developed nation with a rising MMR and the amount of money spend per capita on healthcare, this trend in MMR has garnered increasing attention over the past few decades. Defining and identifying maternal morbidity and mortality has led to confusion and inaccuracy when tracking the rising MMR. Due to increasing claims of underreporting of maternal deaths, the National Center for Health Statistics (NCHS) recommending states add a pregnancy checkbox to the U.S. Standard Certificate of Death. However, implementation of this checkbox was slow and lead to further data inaccuracy. On account of these inconsistencies, the Center for Disease Control (CDC) did not release maternal morbidity or mortality from 2007-2020. The newly released data, unfortunately, shows no significant change in maternal mortality prevalence, with disparities between races persisting. Chronic disease is a significant indicator for maternal morbidity or maternal death. With the prevalence of conditions like obesity, diabetes, and hypertension on the rise in the general population, the role of these disease in adverse pregnancy outcomes must be vigorously studied and mitigated. Additionally, chronic disease are more prevalent in older populations and, with the average maternal age in the U.S. on the rise, providers must understand how to provide the best care for their changing patient demographics. Finally, the U.S. has come to face the growing cries for justice and equity in all things, including healthcare. The MMR is no different. There are significant disparities between women of certain ethic and racial minorities when it comes to likelihood of adverse maternal outcome. These disparities are a product of structural racism that is pervasive throughout healthcare in the U.S. With these factors in mind, researchers, providers, and policymakers must take swift and targeted action to combat the rising MMR, with racial and ethnic minorities as their priority. This work should be informed by the most recent data released by the CDC that shows the trends in rising MMR and racial disparities are persisting despite decades of increased research and attention. With improved tracking methods and a focus on race and chronic disease the U.S. has a chance of decreasing its MMR substantially for the first time in 3 decades.

Acute pesticide poisoning (APP) is a major global public health problem, particularly in low- and middle-income countries (LMICs) including South Africa. However, healthcare professionals (HCPs) worldwide have limited training in handling environmental health risks such as from pesticide exposures. Most HCPs lack basic training on APP and, this presents a challenge to HCPs when diagnosing and notifying pesticide-related poisonings. With a recent increase in mobile application technology, this gives a convenient platform to provide training support for HCPs in their clinical practice. An example is the integration of a South African pesticide notification guideline into an existing Emergency Medicine (EM) mobile application. This pesticide notification guideline (PNG) within the EM mobile application aims to provide an immediate point-of-care tool to help HCPs in diagnosis and notify pesticide poisoning cases. Despite this useful platform for training HCPs, there are limited studies that have evaluated mobile applications or technologies to promote HCPs training in LMICs. This study, therefore, aimed to evaluate the Centre for Environmental and Occupational Health Research (CEOHR)'s PGN adapted for the EM mobile application as a tool for improving HCP's ability to diagnose and report APPs. The protocol (Part A) provides information and a justification for the research study and, describes the methods used to gather and analyse the data. The extended literature review (Part B) provides an overview of studies assessing HCPs' knowledge of and training in pesticide poisonings and the role mobile health technologies play in improving HCPs' knowledge and training in clinical practice. Furthermore, the literature review illustrates the relevant theoretical frameworks and concepts that helps to understand HCPs' behaviour changes when using clinical guidelines or algorithms. The journal manuscript article (Part C) provides this study's research findings and how it could contribute to the body of knowledge. A total of 50 emergency medicine physicians and registrars participated in the

The aims of this study were (a) to determine the prevalence of self-reported physical activity behaviours among adolescents in Grades 8-11 in Western Cape public schools from the YRBS 2, (b) to determine if there were statistically significant differences in these behaviours in comparison to the YRBS 1 and (c) to identify the characteristics of physically inactive participants. The study design was a cross sectional national prevalence school-based quantitative survey and focused on the results from Grade 8-11 classes in public secondary schools sampled in the Western Cape Province only. A total of 1134 students were surveyed across 22 schools.

Includes bibliographical references (leaves 63-64). / This thesis is a case-study of the Office of the Chief Coromer for Ontario. Six coroners working in the Metropolitan Toronto Region were asked to comment on their work through unstructured qualitative interviews. Analysis of the data was conducted using principles of psychodynamics. Various themes arose during the interviews which sugest that the organisation, its policy and practice, provide multiple and often complex defences to its employees who are responsible for carrying out dulies which many would consider unimaginable and unbearable.

Hazard communication mechanisms are essential for informing child caregivers of the dangers associated with chemical products. However, for caregivers to protect their own health and their children from the harm of toxic chemicals, it is important that they understand label information as scientifically intended. Therefore, to accommodate parts of society that have a lack of access to education, the placement of hazard communication pictograms on labels have been introduced to overcome literacy barriers. Many research studies have been conducted on the comprehensibility of pictograms and have found that many barriers exist in end-users being able to understand the intended message behind the pictogram. This study, therefore, explores further the awareness and comprehension of pictogram comprehensibility among caregivers in South Africa that have different backgrounds and living experiences. The study employed a mixed-methods cross-sectional design. The study was conducted with farmworkers from a farm in Paarl and students from the University of Cape Town. Two different data collection tools were used: a face-to-face questionnaire was administered to farmworkers (taking into account literacy barriers) and an online questionnaire to students due to unforeseen circumstances (COVID-19), that put a pause on face-to-face questionnaires being administered among UCT students. Both groups received the same questions except for small adjustments made to the online questionnaire to accommodate the platform. Data for the face-to-face questions were stored in the data collection application, CommCare, and transferred to Excel for quantitative analysis. The online questionnaire was administered through a Google form that was emailed to all students at the university by the Department of Student Affairs and data were then transferred to excel for quantitative analysis. The qualitative data were analysed using a thematic analysis approach where themes were created from theory in the literature and word repetitions that emerged from the respective group responses. Based on the overall results, comprehension of the pictograms varied greatly between caregiver groups indicating harmonization is necessary. Although beyond the scope of this study, the difference amongst the perception of danger warrants further analysis on whether age, educational level, perception of danger, lived experiences, and environmental exposure play a role in the two groups' comprehension of pictograms. The study focused on the already existing Globally Harmonized System of Classification and Labelling of Chemicals (GHS) pictograms as well as newly proposed ones to communicate the “Keep out of reach of children” message. Based on the overall results, what the pictograms represented varied greatly between the different caregiver groups, indicating that comprehension differs largely, and harmonization has not been entirely achieved as desired by the GHS. However, the study concludes that participants place responsibility on the chemical industry to make information about the harmful effects about their products more accessible to communities through educational talks, social media, experts at the point of sale to explain any potential hazards, and through the use of billboards and flyers. Though difficult to achieve, it is suggested that conversation amongst chemical legislators and industry commence on how to include the voice of end-users in the development and implementation of hazard communication strategies.

Includes bibliographical references. / Tuberculosis (TB) and HIV co-infection is association with significant morbidity and mortality, especially in young children. Prevention of tuberculosis in children with HIV is a global health priority and is best achieved through a combination of antiretroviral therapy (ART) and isoniazid preventive therapy (IPT). Current WHO guidelines recommend 6 months of IPT for all HIV-infected children older than 1 year without TB disease; up to 3 years is recommended in high TB prevalence areas. Although both ART and IPT can cause liver injury, data on the safety of IPT in HIV-infected children accessing ART is limited, and no published data exist on the hepatotoxicity risk of prolonged IPT. This thesis aims to address these knowledge gaps.

No description available.

Includes bibliographical references. / South Africa is currently experiencing one of the worst HIV/AIDS epidemics in the world. The epidemic features distinctive age and gender distributions, with young women at greatest risk, and overall proportionally more women affected than men. Current HIV prevention strategies are limited as women's risk is frequently derived from their partners' behaviours rather than their own. The development of a microbicide for HIV prevention may offer the possibility of reducing women’s risk of infection in situations where other more effective methods cannot be used. An environment conducive to introducing a microbicide is critical to avoid some of the obstacles that have historically inhibited similar technological innovations. This study, which formed part of a larger qualitative research project, explored local sexual practices as they related to a female-initiated intra-vaginal product and the broader gender and sexual relations that underpin perceptions around possible microbicide use. An understanding of gender related factors is crucial in exploring women's access and ability to use a microbicide. Twenty-two focus groups and 11 in-depth interviews were held with community participants who resided in Langa, Cape Town. Data was analyzed using a grounded theory approach. Respondents expressed keen support for microbicides, underscored by desperation related to the AIDS epidemic and recognition of women's greater risk. Discussions amongst both women and men around microbicide use revealed numerous ways in which a new preventive technology could impact on broader gender relations. Issues around condom use, partner communication, meanings attributed to changes in vaginal moisture levels, covert use, potential for partner discord, and gender-based violence were linked by respondents to the varying ways in which the microbicide could impact on their daily lives. While the microbicide has the potential to "empower" women, inequitable gender relations and other social and economic problems will need to be addressed in order to halt the spread of the AIDS epidemic in South Africa.